Bury Hospice

Updated 22 May 2019

We inspected this service in response to concerns raised about the storage and administration of controlled drugs and medicines. We carried out an unannounced inspection on 27 February 2019. We did not rate this service at this inspection. We looked at the following key lines of enquiry; in ‘safe’ we looked at incident reporting, medicines management, records and assessing and responding to risk. In ‘well-led’ we looked at culture, governance and monitoring risk in relation to medicines management. During our inspection we spoke with ten members of staff and two patients, we looked at five sets of patient records, they were four inpatients and one day centre patient records.

Bury Hospice is a registered charitable organisation in Bury, Greater Manchester providing hospice services. The hospice opened in 1991. The hospice primarily serves the communities of Bury and the surrounding areas.

The hospice has had a registered manager in post since 11 March 2013; they were registered to provide

• Treatment of disease, disorder or injury
• Diagnostic and screening procedures
• Transport services, triage and medical advice provided remotely

The hospice provided inpatient care and was commissioned to provided eight inpatient beds and a day hospice service, which ran two days per week.

The hospice was funded predominantly by charitable fund raising and through a contribution from the local commissioning group.

Updated 22 May 2019

Bury Hospice is a charity which provides a range of hospice services for adults with a life-limiting illness. The hospice is purpose built and provides accommodation on the Inpatient Unit for up to 12 patients. The hospice also has a Day Hospice and Hospice at Home service. The hospice is purpose built and is situated in a residential area of Bury, not far from the town centre. The hospice is set in well-maintained gardens with adequate parking and clearly defined parking areas for disabled visitors. Services are free to people, with Bury Hospice receiving some NHS funding and the remaining funds are achieved through fundraising and charitable donations. There were six patients being cared for in the Inpatient Unit during our inspection, 20 patients being cared for in the community by the Hospice at Home service and 10 patients attending the Day Hospice. We inspected Bury Hospice on the 21 and 28 March 2017. The first day of the inspection was unannounced. We last inspected Bury Hospice in April 2016 where we found there were several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the lack of audits on the quality and safety of the service, no formal staff supervision, incomplete training records and no business continuity plan in place to deal with emergencies that could arise and possibly affect the provision of care. During this inspection we found that the service had met all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The hospice had a manager registered with the Care Quality Commission (CQC) who was present during the second day of the inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run. We were assisted on the first inspection day by the hospice care team manager; a registered nurse with a wealth of nursing and palliative care experience. The expressions of gratitude relayed to us demonstrated that patients and their families were cared for with the utmost compassion, kindness, dignity and respect. Patients spoke highly of the kindness and caring attitude of the staff. Patients told us they received the care they needed when they needed it and that staff were knowledgeable and committed. Visitors told us they were always made welcome. Discussions with staff and visitors demonstrated to us that the staff recognised and considered the importance of caring for the needs of family members and friends. Patients were supported at the end of their life to have a comfortable, dignified and pain-free death. The nursing and medical staff showed they were highly skilled in pain and symptom control. The staff we spoke with had an in-depth knowledge of the care and support that patients required. We saw that patients were assisted in a way that respected their dignity and privacy. We observed respectful, kindly and caring interactions between the staff, patients and visitors. The patients looked extremely well cared for and there was enough equipment available to ensure their safety, comfort and independence were protected. The care records showed that patients were involved in the assessment of their needs. Their preferred place of care at all stages of their illness and the arrangements in the event of their death were documented. The care records we looked at showed that risks to the patient’s health and well-being had been identified, such as poor nutrition, the risk of developing pressure ulcers and the risk of falls. We saw care plans had been put into place to help reduce or eliminate the identified risks. Suitable arrangements were in place to help safeguard patients from abuse. Policies and procedures for safeguarding patients from harm were in place and staff had received safeguarding training. The hospice had safe and effective systems in place to manage medication. There was medicine support in place from a pharmacist employed by the local hospital who told us they had a good working relationship with the staff and the doctors. We found patients and their families were cared for and supported by sufficient numbers of suitably skilled, competent and experienced staff that were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for patients safely. All areas of the hospice were secure, well maintained and accessible for people with limited mobility. In addition good infection control procedures were in place; making it a safe environment. Systems were in place for carrying out regular health and safety checks and we saw that equipment was serviced and maintained regularly. Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. We saw that patients were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. Patients who were at risk of malnutrition and poor hydration had their food and fluid intake monitored to help ensure their well- being. We were told that a change in the management board structure of the hospice had enabled staff to understand the clear levels of responsibility and accountability within the whole hospice team To help ensure that patients received safe, effective care and support, systems were in place to monitor the quality of the service provided. Systems were also in place for receiving, handling and responding appropriately to complaints.

Updated 22 May 2019

• During our inspection we found that medicines, including controlled drugs and intravenous fluids were stored safely and in line with best practice guidance and organisational policy.
• There was a culture of safety, assessing and responding to patient risk.
• Staff felt able to speak out if they felt something was wrong or could be improved.
• Managers supported staff to be open and honest, report incidents and put patient safety as a priority.

However,

• There were gaps in some audit processes and in particular, there had not been a medicines management audit since March 2018.
• Patients records were not stored in a way that prevented possible unauthorised access. The records’ trolley could not be locked due to a broken lock.
• There was a lack of evidence of training and competency assessments for non-registered staff acting as second checker for controlled drugs.
• Room temperatures where medicines were stored, were not monitored consistently.